Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx xxx Assessment xx Xxxxxxxxxxxx xxx xxx Xxxxxxxxx of Xxxxxxxxx Xxxxxxx xx Xxxxxxx xx Xxxxxxxx Xxxx pursuant xx Xxx No. 209/1997 Xxxx., xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xx xxx xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, xx xxxxxxx

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx for xxxxxxxxx xxx xxxx xxxxxxxx questions xx xxxx xxxxxxx xxxxxxxxx. Xxxxxxx, xxxxxxx xx xxxx xxxxxxxxxxxxx xx xxxxxxxx xxx xxx xxxxx xxxxxxxxxx xx xxxx xxxxxxxxxxx xxx xxx provision of xxxxxxxxx xxxxxxx pursuant xx Xxx xx. 209/1997. Thank xxx xxx xxxx cooperation; xx xx xxxxxx xxxxxxxxxxx.

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X. Please legibly xxxx xx the xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. the victim xx the xxxxxxxx xxx xxx has xxxxxxxx bodily xxxx, xx xxx survivor xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx xxx:

1. Xxxxxxx:

2. Given xxxx:

3. Xxxx xx birth:

4. Xxxxxxxxx xxxxxxx:

5. Mail xxxxxxxx xxxxxxx (xxxxxx xx xxxxxx xxxx xxx permanent xxxxxxx, xxxx):

6. Xxxxx Number:

7. X-xxxx address:

8. Xxxxxxxxxxx:

XX. Xx xxx applicant xx represented xx xxxxxxx xxxxxx ("representative") xx xxx xxxxx xx xxxxxxxxx representation (xxx xxxxxxxx, x xxxxx xxxxx xxxxxxxxxxx xx xxx/xxx xxxxxx) xx on xxx xxxxx xx x xxxxx xx attorney, xxxxxx fill in xxx xxxx xx xxxx xxxxxxxxxxxxxx:

1. Surname:

2. Xxxxx xxxx:

3. Permanent xx registered xxxxxxx:

Xx xxx representative is xxxxxx the xxxxxxxxxxx xx xxxxxx of xxx xxxxxxxxx, xxxxxx xxxx xxxxxx x xxxxxxxx xxxxxxxxxxx him/her xx xxxxxxxxx xxx xxxxxxxxx - x xxxx xx a xxxxx xx xxxxxxxx (xxx xxxxxxxxxxx xxxxxxxxxxxxxx) xx x xxxx xx xxx xxxxx xxxxxxxxxxx (xxx xxxxxxxxx xxxxxxxxxxxxxx) xx xxx xxxxx xxxxxxxxxx xxxxxxxx.

XXX. Xx xxx xxxxxxxxx xx x survivor xx x person xxx has died xx xxxxxxxxxxx xx xxx xxxxxxxxxx criminal xxx, please xxxx xx xxx personal xxxx of the xxxxxxxx:

1. Surname:

2. Xxxxx xxxx:

3. Date xx xxxxx:

4. Date xx xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

7. Relationship xx the deceased xx xxx xxxxxxxxx (x.x. xxxxxx, xxxxxxxx, xx xxxxxxxxxx xxxxxx xx xxxxxx xxxxxxxxx)

Xx xxx applicant xx x survivor of x person who xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx xxx, please xxxxxx x xxxx xx xxx xxxxx xxxxxxxxxxx xxx xxx documents xxxxxxx xxxx xxx xxxxxxxx xxxxxxxxx xx xxx an xxxxxxxxxx xx xxxxxxx the xxxxxxxx (xx xxx xxxx xx a xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxx xx x xxxxx decision on xxx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxxx; xx xxx case xx xxxxxxx couples, xxxxxx attach x xxxxxxxx certificate).

Xxxxxx xxxxxxx the xxxx xx xxxxx xxx crime was xxxxxxxxx xxx, xx xxx xxxxxx xxxxxxx xxxxx xxx xxxxxxxxxxxx xx xxx xxxxx xx x xxxxx xxxx, please xxxx xxxxxxx xxx xxxx xxx the xxxxxx xx which xxx xxxxxx xxxxxxx of xxxx xxxxxxxxxxxx (x.x., xxx date xx xxx xxxxxxx xxxxxx).

XX. Xxxxxx xxxxxxx xxx xxxxxxxx justice xxxxxxxxx (x.x. xxxxxx, xxxxxx xxxxxxxxxx'x xxxxxx, court) xxxxx most xxxxxxxx xxxxxxxxx xxxxxxxx xxxxxxxxxxx. Xxxxx xxx reference xxxxxx xx xxx xxxx related to xxx xxxxxxxxxx xxxxxxxxxxx.

Xx xxxxxxxxx, please xxxxxx xxx xxxxxx xxxxxxxx xx the xxxxxxxxxxxxxx xxxxxxxx xxxxxxx authority xxxxx xxxxx xxxxxxxx xxx xxxxx xx xxx xxxxxxxxxx proceedings (x.x. xxxxxxxxxx xx xxx xxxxxxxxxxxxxxx of xxxxxxxx xxxxxxxxxxx, xxxx xx the xxxxxxxxxx, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx xxx provisions xx §8 of Xxx xx. 209/1997, xxx xxxxxx xx xxxxxxxxx xxxxxxx xxx xx xxxxxxx xx xxxxxxxx xxxxxxxxx on xxxxxxx the xxxxxx xxx made xxx xx all xxxxx xxxxxxxx xx enforce x xxxxx xxx xxxxxxxxxxxx against xxx xxxxxxxx or xxx xxxxx xxxxxx xxxxxxxxxxx xxx xxx harm xxxxxxxx. Xx not xxxx xx this xxxx if xxx xxxxxxxx xxx xxx xxxx xxxxxxxxxx.

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Xxxx in xxxx XxXx xx xxx xxxxxxxxx xx x xxxxxxxx of xx xxxxxxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx the xxxxxxxxx crime.

1. Xxx you a xxxxx, spouse xx xxxxx xx xxx xxxxxx xxx xxxx xx xxxxxxxxxxx of xxx criminal xxxxxxx?

2. Xxx xxx live xx x xxxxxx xxxxxxxxx with xxx xxxxxxxx xxxxxx xxxxx xx the xxxxxxxxxx xx xxx xxxxx?

3. Xxxx you x xxxxxxxxx xx xxx xxxxxx xx was xxx xxxxxxxx obliged xx xxxxxxx xxx?

4. Xx xxx xxxxx xxxxxxx meet xxx xxxxxxxxxx xxxxxxxxx xx xxxxxxx 1 xx 3? Xxxxxx xxxx xxxxx number, xx xxxxx to you.

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According xx xxx provisions xx §2, section 2 xx Xxx xx. 209/1997, x xxxxxx xxx xx x survivor of x xxxxxx xxx xxxx xx xxxxxxxxxxx xx x xxxxxxxx xxx xx xxxxxxxxxx xx xx a xxxxxx if he xx xxx xx x parent, spouse xx child xx xxx xxxxxxxx xxx xxxxx with xxx xx her xx xxx xxxx xxxxxxxxx xx xx the xxxxxx xxx a xxxxxxxxx xx the xxxxxxxx or the xxxxxxxx was required xx support xxx xxxxxx.

Xx xxx applicant xx xxx victim xx a xxxxx xxx xxx suffered xxxxxx xxxx, xxxxxx xxxx xx items XX - XIV.

Xxxxxx attach x xxxxx-xxxxx xxxxxxxxxx xx xxxx xxx xxxxxxxxx xxxxxxxx xx Xxxxxx No. 440/2001 Xxxx. The respective xxxxxxxx xxxxxx xx xxxxxxxx xxxx the xxxxxxxxx xxxxxxxxxxx for xxx xxxxxx'x treatment. Xxxx xxxxxxx xxxxxx xxxx xxxxxxx x xxxxx-xxxxx assessment of xxx xxx xxxxxxxx xxx a xxxxx-xxxxx xxxxxxxxxx xx the xxxxxxxx xx xxx xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx bear in xxxx that xxxx xxx xxxxx-xxxxx assessment xx xxx xxx xxxxxxxx xx relevant xxx the xxxxxxxx xx Act xx. 209/1997. Xxxxxxxxx to xxx xxxxxxxxxx xx §6, xxxxxxx 2 xx Xxx xx. 209/1997, xx xxxxxxxxx xxxxxxx xxxx xx xxxxxxxx xxxxxx the xxxxx xxxxxxxxxx xx xxx pain suffered xx xx xxxxx 100 xxxxxx.

Xxx xxxxxx xxx xxxxxx xxxx xxx xxxxxxxxx xxxxxxx in xxx xxxxxx of CZK 25,000 xx xx xxxxxx xxxxx to xxx proved xxxxx xx xxxxxxx treatment xxx xxxx xxxxxx (§7, xxxxxxx 1, xxxxxx x xx Xxx Xx. 209/1997 Xxxx.). xx you xxxxxx to xxxxx xxx x lump xxx xxxxxxx, there xx xx need xx xxxx in xxxxx XII - XxX.

This includes xxx xxxxxxxx for xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, xxxxxx xx assistant xx xxxx xxx in xxx home or xxxx xxxxxxx xxxxxxxxx, xxxxxxxxx xxxxxxxxxxxxxx xxxxx xxx., xxxxxxxx xxxx xxxxx have not xxxx xxxx by xx xxxxxxxxx xxxxxxx. xx such xxxxxxxx xxx xxx xxxxxx xx documentary xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxx xxxx xxxx into xxxxxxxxxxxxx.

Xxxxxx xxxxxx xxx xxxxxxxxx xxxxxxxxxx xxxx xxxxx to xxx xxxxxxxxxxx.

Xx the xxxxxxxxx is xx xxxxxxxx, these documents xxxxx xxxxxxx a xxxxxxxxx from xxx/xxx xxxxxxxx xxxxxxxxxx the xxxxxxx xxxxxx xxxxxxxxx xx §351 et. xxx. xx Act xx. 262/2006, xxx Xxxxx Xxxxxx Xxxx, xx xxxxxxx. xx xxx applicant xx xxxx-xxxxxxxx, xxxx document xxxxx xx x xxxx xx xxx/xxx xxxx recent xxx xxxxxx. lf xxx xxxxxxxxx xx x xxxxxxx xxxxxx xxx xx able xx xxxxx xxx/xxx xxxxxxxx xxxxxx standing, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxx xxx xxxxxx xx xxx xxxxxxxxxx xxxxxxx. lf xxx xxx reason xxx xxxxxxxxx'x income xxxxxxxxx xxxxxx be xxxxxx, xx xxxxxxxxxxx xxxxx xx affidavit xxx xx xxxxxxxx.

Xx xxxxxx standing has xxxx impaired xx x xxxxxx of xxx criminal xxx xx xxxxx I xxx x xxxxxx. X have not xxx xxxx xxxxxxxxxxx xxx xxx xxxx 1 have xxxxxxxx xx x xxxxxx xx the criminal xxx.

X xxxxxx xxxxxx xxxx X xxxx xxx xxxxxx xxx xxxxx xxx financial xxxxxxx xx any xxxxxxx xxxxx xxx xxxxxxxxxxxx for the xxxx xxxxxxxx as x result xx xxx xxxxxxxx xxx xx xxx xxxxxxx xxxxx xxxx the Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx xxxxxxxxx to §12 xx Xxx Xx. 209/1997 Xxxx., xx the provision xx financial xxxxxxx xxx xxx victims xx criminal xxxx xxx xx xxxxxxxx xxxxxxx other acts, xx amended, X xx xxxxxxx to xxxxxxxxx the Xxxxxxxx xx Justice xxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx for the xxxx xxxxxxxx, xx xx the amount xx the financial xxxxxxx, xxxxxx five xxxxx xxxx the xxxx xx xxxxxxxxx xxx funding xxxxxxx. X xxxx xxxxxxxxxxx xxxx, xxxxx xxx xxxxx of xxx xxxx-xxxx period, X xxx xxxx an xxxxxxxxxxx xxxxxx the Xxxxxxxx of Xxxxxxx xx xxxxx xxx xxxxx'x claim for xxx xxxxxx xx xxx xxxxxxxx support, xxxxxx xxxx x xxxxxx be well xxxxxxxx xx my xxxxxx standing, xxx xxxxx xxxxxx xx xxxx suffered xxx xxx xxxxxx xx xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx that xxxxxxxxxxx xxxxxx xxxxx xx xxxxxxxxxx xxxxxxxxxxx xx xxxxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxxxx of xxxxxxxxxxxxx gaining benefits xxx represent xx xxxxxxx pursuant xx §21, xxxxxxx 1, xxxxxx x) xx Xxx xx. 200/1990 Xxxx., xx offences xx xxxxxxx.

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Xxxxxxxxx xx xxx xxxxxxxxx xx xxx/xxx xxxxxxxxxxxxxx

- Xxxx xxxxxxx xx the xxxxxxxxxxx xxx the xxxxxxxxx of xxxxxxxxx xxxxxxx pursuant xx Xxx Xx. 209/1997, xxx Ministry xx Xxxxxxx xxxxx xxxxxxx xxxxxxx xxx xxxxxx xx a xxxxxx xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx xxxxx xxxxxxxx xx investigation with xxx xxxxxx or x xxxxxxx authority xx xxx xxx xxxxxxxx xxxxxxx xx xxx case. Xxxxxx xxxxx xxxxxx from xxx xxxx of xxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxxxxxxxxx xx xxx xxxxxxxxx documents, the Xxxxxxxx shall xxxxxx xxxxxxx the xxxxxxx xx xxxxxx xxx xxxxxxxxx of the xxxxxxx xxx xxxx xxxxxxx has xxxx xxxxxxxx.

- The applicant xxxxx xx xxxxxxxxxx x victim xx xxx Xxx Xx. 209/1997 Xxxx. only xx xx/xxx has xxxxxxxx bodily harm xx x result xx xxx xxxxxxxxxx xx x crime. X xxxxxxxxx but xxx xxx xxxx xxxxxxxxx xxx xxx xxxxxx'x xxxxxxx xx xxxxxxxx xxxxxxx shall xx xxx xxxxxx xx the xxxxx-xxxxx xxxxxxxxxx xx xxx xxx suffercd (not xxx xxxxxxxxx xx xxxxxx xxxxxxxx), xxxxx xxxx xx xx xxxxx 100 points. Xxxxxxxxx of x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx x xxxxx xxxxx xx xxxxxxxxxx xx be x xxxxxx if xxx xxxxxxxx xx a xxxxxx, xxxxxx xx xxxxx xx the xxxxxxxx xxx xxx xxxxxxxx xxxxxx a xxxxxxxxx xxxx xxx xxxxxxxx xx the xxxx xx xxx/xxx xxxxx xx xx xxx xxxxxxxx supported xx xxx xxxxxxxx xx xxxxxxx the xxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. xx xxx provision of xxxxxxxxx support xx xxxxxxx xx xxxxxxxx xxxx stipulates x xxxxxxxxxx term of 1 xxxx from xxx date xx xxxxx xxx victim xxxxxxx xx xxx xxxx xxxxxx xx xxx xxxxx. Xx xxxx xxxx xxxx xxx coincide xxxx xxx xxxx of xxx xxxxxxxxxx of xxx crime, the xxxxxx shall xxxxxxx xxxxxxxx xx the xxxx xx xxxxx xx/xxx xxxxxxx xx xxx consequences. Xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxx xx xxxxxxxxxxx for xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xxxxxxx xxxxx xxx lapse xx xxx abovementioned xxxxxx.

- Financial xxxxxxx xx xxxxxxx xxx xx x victim xxx has suffered xxxxxx xxxx xx x xxxxxx xx xxx commitment of x xxxxx may xx xx xxx xxxx xx x xxxx xxx xxxxxxxxx xx XXX 25,000 xx xx xxxxxx xxxxx xx lost xxxxxx xx xxx xxxxx of xxxxxxx xxxxxxxxx xx proved xx the xxxxxx, xxxxxxx by xxx xxxxxx previously xxxx xx xxx xxxxxx xx xxxxxxxxxxxx for xxx xxxx incurred. Xxx xxxxx xxxxxx xx xxxx xxxxxxx xxxx not xxxxxx XXX 150,000. Xx, xxxxx xxx xxxxxxxxx xx xxxxxxx, xxx xxxxxx proves that xxx harm xxxxxxxx xxxxxxx the amount xxxxxxxx, xxx xxxxxx xxx xxxxxxx xxxxxxxxxx xxxxxxx up to xxx amount xx XXX 150,000 if xx/xxx xxxxxxx xxx xx xxxxxx xxx xxxxxxxxxxxxxx xxxxxx xx xxxx (x.x., 1 xxxx xxxx the xxxx xx xxxxx xxx victim xxxxxxx xx the xxxx xxxxxx by xxx xxxxx); in xxxx xxxx, xxx amounts xxxxxxx xxxx xxxx xx xxxxx into xxxxxxx.

- An individual xxx xx x xxxxxxxx of a xxxxxx who xxx xxxx xx x xxxxxx of xxx xxxxxxxxxx xx x xxxxx (a xxxxxx, xxxxxx xx child xx xxx xxxxxxxx xxxxxx xx a xxxxxx xxxxxxxxx xxxx xxx xxxxxxxx at xxx xxxx of xxx/xxx xxxxx or xxxxxxxxx by or xxxxxxxx xx xx xxxxxxxxx xx xxx xxxxxxxx) shall xx xxxxxxxx xxxx x xxxx xxx xxxxxxxxx xx XXX 150,000. Xxx total xxxxxx xxxxxxxx xx financial xxxxxxx xxxxx xxx xxxxxx XXX 450,000; xxxxxx xxx xxxxxx xx victims exceed xxxxx, xxx xxxxxx xxxxxxxx xxx victim xxxxx be xxxxxxx xxxxxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. xxxx xxx xxxxxxx xxx xxxxxxxxx of xxx xxxxxxxxx liability of xxxxxxxxx of xxxxx xxxxxxxx xxxxxxx to xxxxxxxxxx liability xxxxxxxxx. Xx xxxxxxx related xx traffic accidents, xxxxxxxxxxxx for xxxxxxxxx xxxxxxxx should xxxx xx xxxxxxxx xx xxx xxxxxxxx providing xxxx liability insurance. Xxxx xx xxxxxxxx xxxxx, xx view xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx xx application xxx xxx xxxxxxxxx xx financial xxxxxxx xx xxxxx xxxx xxx Xxxxxxxx xx Xxxxxxx.

- Xxxxxx xxxx xx xxxx that xxx xxxxxxxxx xxxxxxxxx xxx xxxxxxxxxxxxx required xxx xxx xxxxxxxxxx xxxxx must be xxxxxxxx to xxx xxxxxxxxxxx. Xx the xxxxxxxxx xxxxx xx xx so, the Xxxxxxxx of Xxxxxxx xxxxxx xxxxxxxx xxxxxxx xxx application. Should xxx xxxxxxxxx xxxx xx xxxxxxx xxx xxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxx xxxxxx x xxxxxxxxxxxxx xxxxxxxx, xxxx xxxx xxx xxxxxxx x xxxxxxxx xx xxxxxxxx xxx xxxxxxx xx per Xxx Xx. 209/1997 Xxxx. Xxxx xxxxx xxx, however, xxxxxxxxx xxx filing xx xxxxxxx application.

- Xxxxxx xxxx in mind xxxx xxx xxxxxxxxx xxxxx xx xxxxxxx xx xxxxxx xxx xxxxxxxxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx for xxxx (from xxx xxxxxxxx, insurers etc.) xx xxx account xx xxx Ministry xx Justice xx xx the xxxxxx xx xxx xxxxxxx xxxxxxxx. This obligation xxxx xxx xxxxx xx he/she has xxx received xxx xxxxxxxxxxxx. If xx xxxxxxxxx by the xxxxxx xx an xxxxxxxxxxx, xxx Ministry xx Justice may xxxxx xxx xxxxx'x xxxxx xx xxxxx xxx return of xxx financial support xxxxxxxx xxxxx xxx xxxxx xx xxx xxxx-xxxx term, xxxxxxxx xxxx x xxxxxx xx justified by xxx victim's xxxxxx xxxxxxxx, the total xxxxxx xx xxx xxxx xxxxxxxx xxx xxx amount xx xxxxxxxxxxxx paid xx xxx victim.

Xxxxxx pán/pani/slečna

Ospravedlňujeme xx, xx x xxxxxxxx, x xxxxxx xx xxxxxxxxxx, sme xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx xxxxxxxx. V xxxxxx rýchleho xxxxxxxxx Xxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx činnosti xxxľx zákona č. 209/1997 Zb., xx xxxx xxxxxxxxx xxxxx xxxxxxxxx nevyhnutné. Xxxxxxxx Xxx xx xxxxxxxxxx, xxxxx si xxxxx xxxxxx.

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X. Prosím, xxxxxxx xxxxxxľxx osobné xxxxx x xxxxxxxľxxx - xxxxx xxxxxxxxx xxxx, ktorej xxôxxxxxx xxxx na zdraví, xxxxx osobe xxxxxxxxxx xx osobe, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela:

1. Priezvisko:

2. Xxxx:

3. Dátum xxxxxxxxx:

4. Xxxxxx xxxxxxxx xxxxxx:

5. Xxxxxxxxxxxxxx adresa (v xxxxxxx, xx xx xxxx xx xxxxxx xxxxxxxx bydliska):

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Ak xxxxxxxľx zastupuje xxx xxxxx (xxxxxxxx) xx xxxxxxx xxxxxxxxx xxxxxxxxxx (xxxx. xxxxxxxx dieťa xxxxxx xxxxxxx) xxxxx xx základe xxxxxx x plnej moci, xxxxxxx xxxxx o xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx žiadate xx xxx osobu, xxxx sa xxxxxxx xxxxxxxxxx, ktorá xxxxxxxxxx xxxxxxx. Xxxxx k xxxxxxxx xxxxxxxx xxxxx xxxxx xxxx (xxx xxxxxxxx xxxxxxxxx) xxxxx xxxxx xxxxxxx xxxxx (x xxxxxxx xxxxxxxxx xxxxxxxxxx) alebo xxx xxxxxxx xxxxxxx.

XXX. Xx xxxxxxxľ alebo osoba xxxxxxxxx po osobe, xxxxx v dôsledku xxxxxxxxx xxxx xxxxxxx, xxxxxxx, prosím, aj xxxxx x umretej xxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Dátum xxxxxx:

5. Posledné bydlisko:

7. Xxxxxxxxxx:

8. X akom xxxxxx bola zomretá xxxxx x xôxxxxxx xxxxxxxxx xxxx x xxxxx xxxxxxxľx (otec, xxxxx, xxxxx xxxxxx x spoločnej xxxxxxxxxx):

Xx xx žiadateľ xxxxxx xxxxxxxxxx xx xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx, x žiadosti xx xxxx priložiť xxxxx xxxxxxxx xxxxx a xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, že umretá xxxxx vyživovala xxxxxxxxx xxxxx alebo xxxx xxxxxxxxx xx vyživovať (xx xxxxxx rodič - dieťa pôjde x xxxxx xxxx xxxxx rozhodnutie xxxx x xxxxxxxxxxx povinnosti, xxx xxxxxxxx takou xxxxxxxx bude xxxxxxx xxxx x xxx.)

XX. Xxxxxx, xx xxxxxxx xxxxxxxx peňažnú pomoc xxxxxxxxxxxxxxx xxxxx alebo xxxxxxxx xx peňažný xxxx; x xxxxx xxxxxxx xxxxxxx oznámte xxxxx Xxxxx xxxx.

X. Xxxxxx dátum, xxxx xx obeť xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx.

Xxxxxx dátum xxxxxxxxx trestného činu x ak xx xxxx o xxxxx xxx spôsobenej dozvedela xx xxxxôx, xxxxxx xxxx x xxx (xxxxxxxxx x xxxxxxxxx xxxxxx - xxxxx xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx xxxxx v xxxxxxxx xxxxxx (policajný xxxxx, xxxxxx xxxxxxxxxxxxxx, xxx), xxxxx xxxxxxxxx xxxxx xxxxxxx x xxxxxxxx xxxx. Xxxxxx xx xxxxxxx značku, xxx ktorou xxxxxxxx xxxxxxxxxxxx.

Xx máte x xxxxxxxxxx posledné xxxxxxxxxxx xxxxxx xxxxxxx x xxxxxxxx konaní, xxxxx xxxx predstavu x xxx, x xxxx xxxxxx xx vec xxxxxxxx (napr. xxxxxxxxx x xxxxxxxx xxxxxxxxx xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx ho x xxxxxxxx.

XXX. Xxxxxx, xxxx xxôxxxxx xxx xxxxxxxxx xxxxx xx xxxxxxx xxxxx xx xxxxxxxľx xxxxx xxxx xxxxx, xxxxx xxxxxxxxx xx škodu.

Podľa ustanovenia §8 xxxxxx č. 209/1997 (Zb)., xxxxxxxx xxxxx xx xôxx xxxxxx xxxxx xx xxxxxxxx s xxxxxxxxxxxxx xx xx, či xxxx xxxxxxx xxxxxx xxxxxxx prostriedky xx xxxxxxxxxx nároku xx xxxxxxx xxxxx xx xxxxxxxľx alebo xxxx xxxxx, xxxxx xxxxxxxxx xx xxxxx. Xxxxx xxx xxxxxxxxxxx, ak xxxxxxxľx xxxxxxxxx xxxx xxxxxxxxx.

Xxx XXXX. Xxxxxxx, xx žiadateľ je xxxxxxxxxx xx xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx.

XXXX. Xxxxxx, xx xxx xxxxxxx xxxxxx, xxxxx xxľxx xxxxxxxxx uvedené x §2 odst. 2 zákona x. 209/1997 Xx., xxxxxxxx xxľxx xxôx spľňa xxxxx xxxxxxxxx, xx xx Vám xxxxx xxxxxxxxxxx známe.

1. Boli xxx xxxxxxx, xxxxxxxx xxxxx dieťaťom xxxxx, xxxxx xxxxxxx v xôxxxxxx xxxxxxxxx činu?

2. Xxxx xxx s xxxxxx trestného xxxx xxxx xxxxxxxxx trestného xxxx v spoločnej xxxxxxxxxx?

3. Poskytovala Xxx xxxx xxxxxxxxx xxxx xxxxxx, xx xxxx x xxxx xxxxxxx?

4. Xxľxxxx xxxxx xxxxx xxxxxxxxxxx xxxxxxxxx 1 xx 3? Uveďte xxx xxxxx, xx Xxx xx xxxxx.

Xxxľx xxxxxxxxxxx §2 xxxx. 2 zákona x. 209/1997 Xx. xx xx xxxx xxxxxxxx xxxxx xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, ak je xxxxxxx, manželom xxxxx xxxxxxxx xxxxxxxxx a xxxxxxx x čase xxxx xxxxx x xxx xxxx v xxxxxxxxxx xxxxx xxxxx, xxxxxx xxxxxx poskytoval xxxxx bol xxxxxxx xxxxxxxxxx výživu.

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Body IX. xx XIV. Vyplňte, xx xx xxxxxxxľ xxxx xxxxxx trestného xxxx a xxxx xx xxôxxxxxx xxxx xx xxxxxx.

XX. Uveďte xxxxx, xxxx xx xxxxxxxx xxxxxxxx, xxxxxxxxxx xxxx xx xxxxxxxx xxxxxxxx neschopnosť.

X. Xxxxxxx xxxxx xxxxxxxx ohodnotenia xx bolesť xxxx:

X xxxxxxxx xx musí xxxxxxxx xxxxxx ohodnotenie xx bolesť xxxľx xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx od xxxxxx, ktorý xx xxxxxxxxx. Xxxxx xxxxxxxx xxxxxxx xxxx xxxxxxxxx xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxxx x xxxxxx xxxxxxxxxx sťaženia spoločenského xxxxxxxxxx. Xxxxxxxxxxx, xx xxx účely xxxxxx č. 209/1997 Zb. je xxxxxxxxxx xxx bodové xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxxľx xxxxxxxxxxx §6 xxxx. 2 xxxxxx č. 209/1997 Zb. nemožno xxxxxxxxx' xxxxxxx xxxxx, xx xxxxxx ohodnotenie xxxxxxxxx xxxxxxx xxxxxxxxxx xxxxxxxx 100 bodov.

XI. Xxxxxx, xx žiadate x xxxxxxxxxxx xxxxxxxx xxxxxx xx xxxxx xxxxxxxxx xxxxxxx 25&xxxx;000.- Xx xxxxx xx xxxxxxxx xxxxx xxxxxx xxxxxxx x xxxxxxxx xx xxxxxxxx.

Xxxľx ustanovenia §7 xxxx. 1 xxxx. x) xxxxxx x. 209/1997 Zb. xx xxxxxxx xxxxx xxxxx xxxxxxxxx peňažnú xxxxx xx xxxxx xxxxxxxxx xxxx 25&xxxx;000.- Xx, xxxxx xx xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx xx xxxxxxxx x ušlému xxxxxxx. Xx xx xxxxxxxxxx xxxxxx o xxxxxxx xxxxx xx výške xxxxxxxxx čiastky, xxxxxxxx xx vyplňovať xxxx XXX. - XIV. xxxxx xxxxxxxxx.

XXX. Xxxxxxx xxxxxxx s xxxxxxxx xxxxxx:

Xxx x náklady xx xxxxx, zdravotnícke xxxôxxx, náklady xx xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx na xxxxx x domácnosti či xxxxxxxxxx, xxxxxxx náklady xx xxxxxxx, x xxx. pod xxxxxxxxxx, xx tieto náklady xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxx doložiť, xxxx xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx xxxx xxxx xxxxxľ.

XXXX. Popište xxxxxxxxx xxxxxx xxxxxxxľx xxxx x xx xxxxxx xxxx xx xxxxxx xxôxxxxxxx xxxxxxxx xxxxx.

X žiadosti xxxxxxxx xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx xxxxxxxxxxx.

X prípade, xx žiadateľ xx x zamestnaneckom pomere, xôxxx o xxxxxxxxxx xxxxxxxxxxxxľx o priemernom xxxxxxx xxxľx §351 x nasl. xxxxxx x. 262/2006 Xx., xxxxxxxx xxxxx, x xxxxx neskorších xxxxxxxxx. Xx je xxxxxxxľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, xxxxx xxxxxxxx xxxx xxxxxxxxx opis xxxxxxxxxx xxxxxxxx priznania. Xx žiadateľ xxxxxx xxxxxxxx xôxxxxxx, xxxxxxxx, xxxxx môže xxxxxxx xxxxxxxx sociálnu xxxxxxxx, xxxx xxxxxxxxxx x xxxxx xxxxxxxxxx dôchodku. X xxxxxxx, že x xxxxxxxx závažného xôxxxx nemožno xxxxxxx xxxxxxxxx pomery xxxxxxxľx, x krajnom xxxxxxx xx xxxxx xxxxxxxx xxxxxxxxxx x xxxx xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx nemocenských dávok (xxxxxxxxxxx xôxxxxxx) x xxxx, xxxxxx xxx xxxxxxxľ xxxxxx, xx xxxxxxx po xxxxxx xxxx xx xxxxxx, xxôxxxxxxx xxxxxxxx činom.

K xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx alebo xxxxxxxxx x xxxxx nemocenských xxxxx. X xxxxxxx, xx x dôsledku xxxxx na xxxxxx xxôxxxxxxx xxxxxxxx činom Xxx priznali invalidný xôxxxxxx, uveďte a xxxxxxx xxxx xxxxx.

Xxxx majetkové xxxxxx xx xxxx, xx xxxxxxxx činom, xxxxxxx xxx bol(a) obeťou, xx xxxx sociálna xxxxxxxx zhoršila. Škodu, xxxxx xx xxxxx xxôxxxxx, dosiaľ xxxxxx xxxxxxxx.

Xxxxxx vyhlasujem, xx xxxxx xx xxxxxxx xxxxx xx xxxxxxx xxxxx na xxxxxxxxxxx xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx xxxxxxxxxx(x) x xxxxxxx xxxx xxxxx xxx x Xxxxxx (Slovenskej) xxxxxxxxx.

Xxxxxx xx xxxxxxx, xx xx xxxľx ust. §12 xxxxxx x. 209/1997 Xx., x xxxxxxxxxx peňažnej xxxxxx xxxxxxx xxxxxxxx xxxxxxxx x o xxxxx x x doplnení xxxxxxxxxx xxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx xx xxxxxxx rokov xxx xxx, keď mi xxxxxxxx xxxxx, odviesť xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx čiastky, ktoré xxx dostal(a) ako xxxxxxx xxxxx, a xx xx xx xxxxx poskytnutej pomoci. Xxxxxxx x tým xxxxxx xx vedomie, xx xx uplynutí xxxxxxxxxx xäxxxxxxx xxxx xôxxx požiadať Xxxxxxxxxxxx xxxxxxxxxxxxxx, aby xx x xxxx xxxxx xxxxxx xxxxx na xxxxxxxx xxxxxxxxxxx xxxxxx, xx xxxx sociálna xxxxxxxx xxxx xxxx xxxxxx xxôxxxxxxxx, celková xxxxx xxxxx, ktorú xx spôsobili x xxxxx xxxxxxx, ktorú xxx xxxxxx(x).

Xxxxxx tiež xx vedomie, xx xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx xxxxxxxxx údaja xx xxxx xxxxxxxxx xx xxxxxx získania xxxxxxxxxxxx xxxxxx, xx xôxxx xxxxxxxx xxxxxxxxxx xxxľx §21 xxxx. 1 xxxx. x) xxxxxx x. 200/1990 Xx., x xxxxxxxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx.

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xxxxxx xxxxxxxľx alebo xxxxxxxx

- Xxxxxxxxxxxx xxxxxxxxxxxxxx Xxxxx republiky po xxxxxxx žiadosti x xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx zákona č. 209/1997 Zb. xxxxxxx xxx xxxxxx x udelí poradové xxxxx. Potom xxxx xxxxxxxxxx na xxxxxxx xx na inom xxxxxxxx xxxxxx xxxľx xxxxxxxxxxx okolností prípadu. Xx xxxxx mesiacov xx xxxxxx xxxxxxxx x xxxxxxxxxx xxxxxxxxxx xxxxxxxx buď xxxxx xxxxxxxx alebo xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X xxxxxx zákona č. 209/1997 Zb. bude xxxxxxxľ xxxxxxxxxx xx xxxx xxx v prípade, xx xx x xôxxxxxx xxxxxxxxx xxxx xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, xxx xxxx postačujúcou xxxxxxxxxx xx priznanie peňažnej xxxxxx xxxxx obeti xx xxxxx bodového xxxxxxxxxxx xxxxxxx (nie xxxx sťaženie spoločenského xxxxxxxxxx) dosahujúceho xxxxx 100 xxxxx. Za xxxx xx xxxxxxxx xx xxxxx pozostalá xx xxxxx, ktorá x dôsledku xxxxxxxxx xxxx xxxxxxx, xx xxxx xxxxxxx, manželom xxxxx xxxxxxxx xxxxxxxxx x zároveň x xxxx xxxx xxxxx x xxx xxxx x xxxxxxxxxx, xxxxx xxxxx, xxxxxx xxxxxxx xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx xxxxxxxxx xxxxxx xxxxxxx trestnej xxxxxxxx xxxxxxxxx prekluzívnu (xxxxxxxx) xxxx 1 roka xxx xxx, keď xx xxxx xxxxxxxxx x škode xxôxxxxxxx xxxxxxxx xxxxx. Xx xxxxx xxxx xx xxx xx deň xxxxxxxxx trestného xxxx, xxxx dokazuje xxxxxxx, xxxx xx xx xxxxx. Xxxxxxxxxxxx spravodlivosti xxxôxx vyhovieť žiadostiam x xxxxxxxxxxx xxxxxxxx xxxxxx, ktoré xx xxxxxxxx xx xxxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx xx xx žiadosť xxxxx, xxxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx xxxxx na xxxxxx, xxxxxxxx x xxxxxxxxx sume 25&xxxx;000.- Xx alebo vo xxxxx, xxxxx predstavuje xxxxxxxxxx xxxxxx xx xxxxxxx, xxxxxxxxxx náklady xxxxxxx x xxxxxxxx, xxxxxxx o súčet xxxxxxxx čiastok, xxxxx xxxx x xxxxxx xxxxxxx xxxxx xx xxxxxxx; pomoc xx xxxxxx xxxxx nesmie xxxxxxxxxx sumu 150 000.- Xx. Xx xxxx - xx tom, xxx jej poskytli xxxxx - xxxxxxxx, xx xxx xxxxxxxxx xxxxx xx xxxxxx xxx xx, ktorá xxxx xxxxxxxxx na xxxxxxxxxxx pomoci, xx xxx xxxxxxx x xxxxxx xxxxxxxxxx týmto xxxxxxx xxx možno xxxxxxxxx pomoc opäť, x xx xx xx maximálnej xxxxx 150&xxxx;000.- Xx; xxxxxx xx xxxxxxxxxx xx xxxxxxx, ktoré už xxxx xxxxxxxxx.

- Xxxxxxxx xxxxx, xxxxx xx xxxxxxxxxx xx obeti, xxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx (xx xxxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx x xxx xxxx v xxxxxxxxxx, xxxxx jej zomretý xxxxxxxxxx, či xxx xxxxxxx xxxxxxxxxx výživu), xx poskytne xxxxxxx xxxxx x paušálnej xxxx 150&xxxx;000.- Xx; xxxxx vo svojom xxxxx xxxxxx xxxxxxxxxx xxxx 450 000.- Xx, x xx xx xxxxx xxxxx viac xxx xxx xxxxx, xxxxxxxxxxx xxxxxxx sa xxx každej obeti xxxxxxxxx kráti.

- Zákon č. 209/1997 Zb. nenahradzuje xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, na xxxxx nadväzuje povinné xxxxxxx xxxxxxxxx zodpovednosti. Xxxxx xx xxxxxxxx x xxxxxxxxxxxxxx dopravných xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx poistenie xxxxxxxxxxxxx, o poskytnutie xxxxxxxxx xxxxxxx. Xxx x celkom xxxxxxxxxxx xxxxxxxxx x xxxxxxxxxxxxx xx xxxxxxxxx výnimočné xxxxxxxxx xx xxxxx xxxxxx ministerstvo spravodlivosti x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, xx xx xxxxxxxxxx priložiť xxxxxx dostupné doklady x xxxxxxxxxx, xx xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx xxxxxxxxx. Xx xxx žiadateľ xxxxxxx, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx xxxxxxx. Xx xxxxxx xxxxxxxxxx x xxxxxxx xxx dodatočne xxxxxx, táto skutočnosť xôxx xxx xôxxxxx xxxxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. Xx však xxxxxxxxxx xxxxxxx podať xxxx xxxxxxx.

- Xxxxxxxxxxxx, xx xx xxxx žiadateľovi xxxxxxxxxx xxxxxxx pomoc, xxxxxxxľ xx xx xxxxxxx xxxxx xxx xxx xxxxxxxxxxx pomoci xxxxxxx xx účet xxxxxxxxxxxx xxxxxxxxxxxxxx sumy, xxxxx xxxxxx ako xxxxxxx škody (xx xxxxxxxľx, xxxxxxxxx a xxx.) xx xx xxxxx xxxxxxxxxxx pomoci. Xxxx xxxxxxxxx xxxx, xx mu xxxxx xxxxxxxxxx. Na základe xxxxxxxx xxxxx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x mene štátu xx xxxxxxxx stanovenej xäxxxxxxx xxxx xxxxx xxxxx na xxxxxxxx xxxxxxxxxxx peňažnej xxxxxx. Xx takýto xxxxxx xxôxxxxxxx xxxxxxxx situácia xxxxx, celková xxxxx xxxxx, xxxxx xxx xxôxxxxxx, x xxxxx xxxxxxx, ktorú obeť xxxxxxx.